Definitions for the levels of evidence (I–IV) can be found at the end of the "Major Recommendations" field.
Guidelines
Intensive combination therapy protects against progression of diabetic nephropathy. (Level II evidence for Type 2 diabetes – single RCT) and Level III evidence for Type 1 diabetes – single small cohort study, small volume)
Suggestions for Clinical Care
(Suggestions are based on Level III and IV evidence)
Patient motivation, compliance and total cost of therapy may be limiting issues. Multi-factorial therapy is likely to be embraced long-term only by highly motivated patients. For motivated patients, the limited available data suggest possible synergistic effects of multifactorial intervention, for both micro- and macro-vascular endpoints.
Definitions:
Levels of Evidence
Level I: Evidence obtained from a systematic review of all relevant randomized controlled trials (RCTs)
Level II: Evidence obtained from at least one properly designed RCT
Level III: Evidence obtained from well-designed pseudo-randomized controlled trials (alternate allocation or some other method); comparative studies with concurrent controls and allocation not randomized, cohort studies, case-control studies, interrupted time series with a control group; comparative studies with historical control, two or more single arm studies, interrupted time series without a parallel control group
Level IV: Evidence obtained from case series, either post-test or pretest/post-test
